GENU VARUM

It is a deformity in which the knees go outwards and the legs go inwards in relation to the thigh.

This type of deformity may be physiological up to 2 years of age, characterized being bilateral, symmetrical, painless and self-limited with normal growth.

Treatment of physiological genu varum is regular follow up to confirm progress of improvement. So it’s important to differentiate between physiological and pathological genu varum cases since the latter need treatment.

GENU VARUM

Etiology of genu varum

May be due to calcium and vitamin D deficiency or any disease that can lead to abnormal bone growth or malnutrition.
Abnormal skeleton development like Blount’s disease or tumor causing single limb deformity.
Other reasons as epiphyseal fractures or sports related causes eg. Horse riding.

Blount's disease (Tibia Vara)

Blount’s disease is a progressive pathologic genu varum centered at the tibia due to abnormal growth of upper medial tibia epiphysis. It can occur at any age from childhood to adolescence, there are 2 types:

Infantile Blount’s:
- Disease occurs in children 2 to 5 years old.
- More common in males than females.
- Bilateral in 50% of cases.
Adolescent Blount’s:
- Disease occurs in children older than 13 years old.
- Less common.
- Less severe.
- More likely to be unilateral.

Diagnosis of genu varum

Clinical examination by measuring the distance between both knees, full examination of the spine and feet should be carried out.

Plain x-ray standing antero-posterior view showing the whole lower limbs.

MRI may be indicated for some cases.

Treatment of genu varum:

Medical treatment:

Calcium and vitamin D are administered and follow up is done by repeated laboratory tests.

Surgical treatment:

Depends upon the age of the patient, clinical and radiological investigations.

Surgical treatment could be carried out by one of the following methods:

Growth readjustment of the upper lateral tibial physis by the 8-plate.
High tibial osteotomy.
In advance cases patient may need external fixation (Ilizarov) for correction of the deformity.

Treatment:

A case of bilateral genu varum treated by hemiepiphysiodesis:

Clinical photo before surgery	Clinical photo 16 months after surgery
Intra operative photo from c. arm	2 month after surgery

A case of bilateral genu varum treated by hemiepiphysiodesis:

Clinical photo before surgery	Clinical photo 5 years after Surgery
Plain x-ray before surgery	Plain x-ray 5 years after surgery